Public Health and General Preventive Medicine Content Outline

Test Specifications

Domain	Percent of Exam
I. Clinical Preventive Medicine	25%
II. Public and Population Health Health of the Public and Populations 20% Public Health Program Management and Administration 10% Global Health 5%	35%
III. Epidemiology Epidemiology 10% Biostatistics 5% Informatics 5%	20%
IV. Environmental and Occupational Health	10%
V. Health Services Administration	10%

Domains, Tasks, Knowledge

I. Clinical Preventive Medicine

Tasks

• T1.1 Perform or obtain comprehensive individual and family health history, including but not limited to medications, immunizations, occupation, environmental exposures, hobbies, travel, sexual health, lifestyle, complementary and alternative therapies, local epidemiologic considerations, injury risk.
• T1.2 Assess and analyze an individual’s health risks considering personal, family, and exposure history, lifestyle behaviors, risk-taking, and adverse childhood events.
• T1.3 Perform physical exam and order appropriate, evidence-based screenings and tests to guide care decisions.
• T1.4 Screen for, identify, assess, and address structural and social determinants of health.
• T1.5 Identify and screen for substance use and addiction.
• T1.6 Diagnose and treat medical conditions, taking into account structural and social determinants of health, and assist patient in navigating to available resources.
• T1.7 Manage acute and chronic diseases of public health significance using information from patient history and physical exam findings.
• T1.8 Provide evidence-based treatment options and patient education to reverse chronic disease progression and improve health outcomes and quality of life.
• T1.9 Prioritize and provide evidence-based guidance, advice and/or interventions in order to improve health outcomes and functional status.
• T1.10 Provide patient education, anticipatory guidance, and counseling related to risk factor reduction.
• T1.11 Promote behavioral change leading to health improvement using evidence-based interventions.
• T1.12 Assess risk related to travel and provide preventive guidance.
• T1.13 Incorporate principles of shared decision-making in all aspects of patient encounter.
• T1.14 Provide interdisciplinary care and coordination to improve patient outcomes.
• T1.15 Communicate with patients regarding treatments or interventions using a variety of media (e.g., patient portals, brochures, written instructions).
• T1.16 Coordinate with community partners and resources to advance health equity.
• T1.17 Utilize evidence-based guidelines to develop policies and procedures for administrative decision-making and/or implementation in clinical medicine.

Knowledge

• K1.1 Primordial, primary, secondary, tertiary, and quaternary prevention
• K1.2 Signs, symptoms, diagnosis, and management of somatic and mental diseases and disorders that are prevalent in, or cause disproportionate or premature morbidity or mortality in certain populations
• K1.3 Health risks (e.g., personal, family, and exposure history, lifestyle behaviors, risk-taking, adverse childhood events)
• K1.4 Screening tools and interventions to address social and structural determinants of health
• K1.5 Approaches to addiction and substance use disorders, including available resources for management
• K1.6 Communicable and non-communicable diseases
• K1.7 Guidelines and recommendations disseminated by clinical medicine and public health authorities (e.g., USPSTF, CDC STI)
• K1.8 Vaccination schedules and immunization recommendations (e.g., ACIP)
• K1.9 Recommended preventive screenings related to health conditions and exposures
• K1.10 Principles, methods, and tools for screening
• K1.11 Methods and approaches for injury prevention
• K1.12 Basic tenets of the six pillars of lifestyle medicine
• K1.13 Lifestyle modification, wellness programs, and nutritional approaches for the prevention of diseases and disorders
• K1.14 Principles of patient-centered care and shared-decision-making
• K1.15 Principles of health literacy that apply to patient counseling and education
• K1.16 Techniques and applications for communicating with individual patients via a variety of methods and technologies (e.g., telephone apps, directly observed therapy, wearable devices)
• K1.17 Theories, techniques, and strategies for influencing behavioral change (e.g., motivational interviewing, positive psychology, nudging, behavioral change models)
• K1.18 Approaches and methods for coordinating interdisciplinary care

II. Public and Population Health

A. Health of the Public and of Populations

Tasks

• T2.1 Identify and monitor at-risk groups in need of special services due to social and structural determinants of health or other risk factors (e.g., at risk of suicide, substance use).
• T2.2 Perform population or community health assessment (including defining health questions, collecting, organizing, analyzing, and interpreting data) to determine potential relationships, correlations, and/or causalities between factors and variables related to health outcomes.
• T2.3 Perform outbreak investigation and disease surveillance.
• T2.4 Identify barriers in order to increase access to health care (e.g., eliminating co-pays).
• T2.5 Develop outreach efforts and interventions for specific populations at risk (e.g., provide mobile vaccine clinics).
• T2.6 Identify, implement, and evaluate public health and population health initiatives to address health disparities and improve health outcomes.
• T2.7 Identify or develop metrics to evaluate program process and outcomes, improve programs, and develop new programs to improve the health of the public and of specific populations.
• T2.8 Investigate and analyze how policies lead to health disparities and inequities.
• T2.9 Translate evidence-based knowledge and guidelines into recommendations and policy proposals for healthcare, including at physician and system levels.
• T2.10 Develop messaging appropriate to the audience to provide accurate and timely information on issues related to public health.
• T2.11 Prevent disease (i.e., primary prevention) for those at risk in the community, through community-level education, screening, immunization, and control measures.
• T2.12 Mitigate and address health conditions (i.e., secondary prevention) through the use of screening, improving access to care, and providing treatment in collaboration with community organizations, healthcare systems, and Departments of Health.
• T2.13 Manage existing health conditions (i.e., tertiary prevention) by implementing public health measures and putting facilities and services in place to reduce the spread of disease.

Knowledge

• K2.1 Ten essential public health services and other emerging models
• K2.2 Structure, functions, and responsibilities of major international, federal, tribal, territorial, state, and local public health agencies
• K2.3 Sources of population health data, measures, and indicators related to physical and mental status, health risk, healthcare access and utilization, socioeconomic indicators, health and social inequity
• K2.4 Definition of populations (e.g., geographic, community, ethnicity/race, insured)
• K2.5 Population-based risk characterization, assessment, and mitigation methods, approaches, and strategies
• K2.6 Public health issues related to disease processes that disproportionately affect populations at risk (e.g., homeless, LGBTQ+, rural/urban, migrants/refugees, those engaged in risk-taking behaviors, Disability, Access, and Functional Needs (DAFN) community)
• K2.7 Communicable and non-communicable diseases of public health significance, including emerging diseases
• K2.8 Protocols for reportable diseases (e.g., identify, manage, report, respond)
• K2.9 Outbreak management tools (e.g., CDC tools, distribution of diagnostic tests, contact tracing)
• K2.10 Real-time data collection methodologies for community health threat assessment and systems for information dissemination
• K2.11 Public health and community responses to substance use and addiction
• K2.12 Social and structural determinants of health
• K2.13 Structural and systemic barriers to care that drive healthcare and health disparities
• K2.14 Measures to address health inequity
• K2.15 Adverse childhood events (ACEs) impacting health
• K2.16 Principles, methods, and approaches to mass health communication with the public, the media, policy makers, and other stakeholders, (e.g., using social media, radio interviews, podcasts, television interviews)
• K2.17 Risk communication
• K2.18 Implementation science and methods to promote the integration of research findings and evidence into health-care policy and practice
• K2.19 Discourse analysis (including consideration of impact of message to specific patients or populations; efficacy of communication; context of culture, values and beliefs)
• K2.20 Policy development approaches, guidelines, practices
• K2.21 Policy analysis and evaluation methods (e.g., prevention effectiveness, impact)

B. Public Health Program Management and Administration

Tasks

• T2.14 Identify public health priorities to guide program development.
• T2.15 Develop projects and programs to meet public health needs.
• T2.16 Collaborate with all sectors involved in the public health system (government, military, community, clinical care, media, private sector, non-profits, NGOs, other stakeholders) to improve health outcomes.
• T2.17 Identify funding sources for program development and administration.
• T2.18 Evaluate the quality of public health programs, services, and outcomes (including unintended consequences) by collecting data and measuring against metrics.
• T2.19 Promote research to develop insights and advocate for and/or drive improvements in public health programs and services.

Knowledge

• K2.22 Public health laws, legal authority of levels of government, constitutional protections relevant to public health, and the role of administrative agencies
• K2.23 Governmental entities and regulatory agencies involved in the funding and provision of public health services
• K2.24 Stakeholder advocacy principles and methods
• K2.25 Principles and models for program design, development, management, and administration (e.g., collaborative models, public/private partnerships, community-based public health models)
• K2.26 Emergency response procedures related to public health concerns, including National Incident Management System (NIMS)

C. Global Health

Tasks

• T2.20 Identify communicable and non-communicable diseases of global concern and related data sources
• T2.21 Implement programs to improve the provision of quality health care and health outcomes through collaboration with local capacity and major stakeholders.
• T2.22 Support health system improvement and strengthen capacity using the principles of priority setting, funding sources and financing mechanisms, resource allocation, program management and administration.
• T2.23 Work within scope of practice defined by local regulation and laws.

Knowledge

• K2.27 One Health
• K2.28 International health organizations (e.g., multilateral, bilateral, non-governmental organizations [NGOs])
• K2.29 National models or health systems for provision of health care, and their financing mechanisms
• K2.30 Global burden of disease and determinants of epidemiological transitions, and sources of data on disease burden and trends
• K2.31 Effect of globalization on health (e.g., how travel and trade contribute to the spread of communicable and noncommunicable diseases)
• K2.32 Global health surveillance (e.g., Global Outbreak Alert and Response Network [GOARN], international health regulations)
• K2.33 Major public health strategies and global health interventions to reduce disparities and improve health outcomes
• K2.34 Sustainable Development Goals (SDGs)
• K2.35 Emerging and re-emerging diseases, public health emergencies of international concern
• K2.36 Antimicrobial resistance and stewardship
• K2.37 Cultural competence/cultural humility
• K2.38 Ethics and the protection of human rights in the context of global health (e.g., role of pharmaceutical and technology industries, resource allocation, humanitarian response, displaced populations)

III. Epidemiology, Biostatistics, and Informatics

A. Epidemiology

Tasks

• T3.1 Evaluate the quality of evidence from statistical and epidemiologic studies including the strengths and weaknesses of the design.
• T3.2 Evaluate the role of bias and systematic error as these impact data, study design, and the population being studied, including consideration of equity and inclusion.
• T3.3 Assess, organize, and synthesize available scientific information to guide medical decision-making, policy and program planning, and to inform future research initiatives.
• T3.4 Design and conduct studies related to public health issues to develop policies and solutions and make recommendations based on evidence to address identified issues.
• T3.5 Design, identify, report, and respond to epidemiologic surveillance (passive and active).
• T3.6 Communicate recommendations for public health program management and administration based on the analysis of epidemiological research.

Knowledge

• K3.1 Legal and ethical aspects of epidemiologic studies, including human subjects review, working with vulnerable populations, screening, informed consent, conflicts of interest, community involvement, archived samples, data security and privacy (e.g., HITECH, HIPAA)
• K3.2 Epidemiology of infectious diseases, including surveillance methodology to monitor, control, and prevent infectious diseases; characteristics of infectious agents; vector and host characteristics; environment characteristics; modes and mechanisms of disease transmission; measures of disease outbreaks; outbreak investigation and intervention; zoonotic diseases
• K3.3 Indicators and measures of infectious and non-infectious diseases and medical/personal injuries (e.g., health indicators, measures of the occurrence of disease, measures of mortality, evaluation of programmatic interventions)
• K3.4 Data sources (e.g., vital records; databases for reportable and notifiable conditions; population health surveys; registries; morbidity and mortality reports; census)
• K3.5 Research design including hierarchy of study design and hierarchy of evidence, and value of various study designs for different stages of research development or public health actions, including observational studies, experimental and quasi-experimental studies, systematic review and meta-analyses, platform studies
• K3.6 Epidemiologic associations and data interpretation, bias (systematic error), confounding, and generalizability
• K3.7 Causality (e.g., criteria, dose effect, strength of association, biological plausibility, reproducibility)
• K3.8 Measures of effect and effect size, including attributable risk (risk difference), relative risk, and odds ratio
• K3.9 Decision analysis processes, methods, and tools (e.g., decision trees, modeling, receiver operating characteristic (ROC) curves, Bayesian)
• K3.10 Interpretation and evaluation of tests, including likelihood ratios, positive and negative predictive values/positive and negative percent agreements, application of results to the population or the individual

B. Biostatistics

Tasks

• T3.7 Identify methods, tools, approaches, and assumptions and limitations with respect to a research question or study design.
• T3.8 Perform data analyses using various statistical methodologies.
• T3.9 Interpret the results of biostatistical analyses.
• T3.10 Communicate study results to stakeholders to inform decision-making.

Knowledge

• K3.11 Types, uses and limitations of statistics and statistical measures
• K3.12 Statistical inference and hypothesis testing
• K3.13 Role of probability in study interpretation
• K3.14 Bivariate analysis, randomization
• K3.15 Multivariate analysis
• K3.16 Parametric and non-parametric tests
• K3.17 Significance tests
• K3.18 Causes of variations in data
• K3.19 Potential application of predictive modeling techniques

C. Informatics

Tasks

• T3.11 Extract information from EMRs and health information exchanges (HIEs), data repositories, registries, and warehouses.
• T3.12 Leverage interoperability to exchange and analyze information and data from different sources.
• T3.13 Use informatics to identify underserved populations in order to support and improve care delivery.
• T3.14 Identify early onset of diseases in populations by accessing and leveraging information in available data sets in order to take preventive measures.
• T3.15 Use data visualization and visual analytics to communicate information.

Knowledge

• K3.20 Standards for storing, securing, protecting, managing, sharing, and manipulating data
• K3.21 Standard related to interoperability
• K3.22 Types of data structures (e.g., flat files, relational databases, pivot tables)
• K3.23 Categories of data storage (e.g., warehouses, repositories, registries, and programs for data storage such as prescription monitoring and disease surveillance systems)
• K3.24 Health information exchanges (HIEs)
• K3.25 Terminology and uses of application program interfaces (APIs)
• K3.26 Electronic health records, including terminology, basic functions and concepts
• K3.27 Informatics tools appropriate to research question and study design
• K3.28 Basic concepts and limitations of data mining and data dredging
• K3.29 Geographic information system (GIS) mapping
• K3.30 Data organization, presentation, and visualization techniques and software
• K3.31 Concepts and uses for artificial intelligence and machine learning in public health research
• K3.32 Uses of dashboards for individual and population health
• K3.33 Digital technologies and applications (e.g., digital health, patient-generated data, use of social media)

IV. Environmental and Occupational Health

Tasks

• T4.1 Review and interpret comprehensive evaluations of the environment to identify risks to which individuals or populations are exposed.
• T4.2 Develop and implement plans to mitigate, manage, and/or treat individual, community, and population environmental health risks (including but not limited to air quality, water and food quality, physical stressors, solid waste and hazardous materials management, built environment).
• T4.3 Identify the factors that impact the design and development of interventions and health, wellness and lifestyle initiatives to address health disparities arising from environmental conditions.
• T4.4 Determine the efficacy of environmental health and safety initiatives and programs, and recommend modifications.
• T4.5 Develop incident management and response plans in collaboration with relevant stakeholders and communities.
• T4.6 Consult on emergency response management and logistics, including but not limited to Emergency Operations Centers and Incident Command Centers.
• T4.7 Develop and communicate environmental policies related to the protection of human health at all governmental levels.
• T4.8 Assess individuals using current standards and guidelines to determine suitability for duty, return to work, school, play/leisure, travel or other essential life activities.
• T4.9 Identify environmental and occupational exposures in individuals that impact health and employment.

Knowledge

• K4.1 Signs and symptoms of diseases related to occupational and environmental exposures
• K4.2 Environmental factors related to community health (e.g., air and water quality, sanitation, heat and cold stress, food safety, household and workplace injuries, noise)
• K4.3 Health conditions related to environmental factors of natural and/or man-made disasters (e.g., climate change, war, migration, resettlement, biological terrorism)
• K4.4 Environmental conditions (e.g., the built environment, food deserts) and their impact on social determinants of health
• K4.5 Standards for environmental factors (e.g., lead, water contamination)
• K4.6 Environmental agents, toxicants, and hazards (e.g., chemical, biological, household products, pesticides, radiation nuclear) and sources of information (e.g., ATSDR)
• K4.7 Relationships between levels of environmental hazards or acute or chronic exposures and health consequences (e.g., cancer clusters, asthma, lead poisoning)
• K4.8 Concepts of environmental epidemiology to assess environmental risks
• K4.9 Environmental sampling techniques and interpretation of results
• K4.10 Toxicology principles (e.g., interaction of exposures and individuals, toxicokinetics, toxicodynamics) and methods (e.g., hazard identification, exposure assessment, dose response assessment, risk characterization and management)
• K4.11 Quarantine procedures related to environmental exposures
• K4.12 Procedures to manage nuclear, biological, chemical (NBC) exposures
• K4.13 Protocols and procedures for emergency response prioritization, logistics, and management
• K4.14 Regulatory policies related to environmental health concerns
• K4.15 Communication methods to reduce/mitigate misinformation and effectively inform the public about environmental risks following natural and/or man-made disasters

V. Health Services Administration

Tasks

• T5.1 Collaborate with organizational stakeholders to develop policies related to resource allocation, access, and provision of care that are in accordance with ethical and socially responsible principles.
• T5.2 Foster teamwork and collaboration on interdisciplinary healthcare teams, within healthcare organizations.
• T5.3 Direct and administer clinical programs.
• T5.4 Identify methods for financing public health initiatives, assist in securing financing, and participate in budget development.
• T5.5 Participate in the development, implementation, and evaluation of organizational and programmatic initiatives (e.g., implement new EHR system).
• T5.6 Implement patient safety interventions in the healthcare environment.
• T5.7 Apply measures of organizational quality (e.g. structural, process, outcome measures) to improve patient care and healthcare system functioning.
• T5.8 Serve as preventive medicine consultant to senior leadership and other managers at program and system levels.

Knowledge

• K5.1. Ethics of service provision (e.g., prioritizing care, access to resources, equality vs equity)
• K5.2. Healthcare system models, including organization, funding, and delivery
• K5.3. Demand and disease management strategies and programs
• K5.4. Financing and delivery concepts and participants (e.g., financing mechanisms, public and private sector)
• K5.5. Budgeting terminology and methods (e.g., fiscal year, projections, return on investment)
• K5.6. Change management principles and organizational change models
• K5.7. Leadership and management principles, theories, and methods
• K5.8. Program management principles and methods
• K5.9. Negotiation and influencing theories and methods
• K5.10. Health outcome measurement (e.g., HEDIS, public health measures)
• K5.11. Purpose and functions of human resources departments
• K5.12. Quality improvement and management, including quality measurement, quality assurance, and improvement; continuous quality improvement (CQI) principles and practices; medical errors and patient safety; patient satisfaction and functional status, program evaluation and improvement; root cause analysis (RCA); and Plan-Do-Study-Act (PDSA) model